iopamidol

Action and Spectrum

Actions and Spectrum 

Action: Drug works by absorbing X-rays and enhancing the contrast between different structures within the body during imaging procedures. It contains iodine, which has a high atomic number and thus effectively absorbs X-rays. When administered into the body, iopamidol circulates through the bloodstream and selectively accumulates in the target areas, such as blood vessels or organs, due to its hydrophilic properties. This accumulation results in improved visualization of these structures during imaging. 

Spectrum: iopamidol has a broad spectrum of imaging applications. It is commonly used in diagnostic radiology, particularly for CT scans and angiography procedures. Some specific applications of iopamidol include: 

Contrast-enhanced CT scans: Drug is frequently employed in CT imaging to improve the visibility of blood vessels, organs, and tissues. It helps in the diagnosis and evaluation of various conditions, such as tumors, vascular abnormalities, and infections. 

Angiography: drug is used for angiographic procedures, where it is injected directly into blood vessels to visualize the vascular system. It aids in the diagnosis of conditions like arterial blockages, aneurysms, and vascular malformations. 

Drug Interaction

Adverse Reaction

Frequency defined  

1-10% 

Hives (1%) 

Hypotension (1%) 

Bradycardia (1.3%) 

Flushing (1.8%) 

Angina pectoris (3%) 

Hot flashes (3.4%) 

<1% 

Abnormal pulmonary circulation 

Right ventricular abnormalities 

Cyanotic heart disease 

Black Box Warning

Black Box Warning:  

Not used for intrathecal 

Contraindication / Caution

Contraindication/Caution:  

Hypersensitivity or Allergy: Individuals with a known hypersensitivity or allergy to iopamidol or any other iodinated contrast agents should not receive iopamidol. Reactions including anaphylaxis, which is a life-threatening condition. 

Hyperthyroidism: drug contains iodine, and in rare cases, it may exacerbate hyperthyroidism, a condition characterized by excessive thyroid hormone production. Therefore, caution is advised when using iopamidol in individuals with hyperthyroidism. 

Severe Renal Impairment: drug is excreted primarily by the kidneys. Patients with severe renal impairment, such as end-stage renal disease or acute kidney injury, may have difficulty clearing the contrast agent from their system.  

Severe Cardiovascular Disease: Individuals with severe cardiovascular conditions, such as congestive heart failure, unstable angina, or recent myocardial infarction, may be at increased risk when receiving iopamidol.  

Pheochromocytoma: drug can induce the release of catecholamines, which can be problematic in individuals with pheochromocytoma, a rare adrenal gland tumor that produces excessive adrenaline and noradrenaline. Administration of iopamidol in such cases should be approached with caution. 

Multiple Myeloma: Patients with multiple myeloma, a cancer of plasma cells, have an increased risk of developing a rare condition called contrast-induced nephropathy. The use of iodinated contrast agents, including iopamidol, in these individuals should be carefully evaluated, and alternative imaging methods may be considered. 

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: B 

Lactation: Excreted into human milk is unknown 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester. 

Category B: There were a lack of studies on pregnant women and no evidence of risk to the fetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology:  

iopamidol is a water-soluble, non-ionic iodinated contrast agent used in medical imaging procedures such as X-rays, computed tomography (CT) scans, and angiography. It belongs to the group of contrast agents known as iodinated radiopaque compounds. 

Pharmacodynamics:  

Drug enhances the visibility of blood vessels and certain body structures during imaging procedures. It does this by attenuating X-rays and allowing the visualization of organs, blood vessels, or tissues that would otherwise be difficult to see. iopamidol achieves its radiographic contrast by containing iodine, which has a high atomic number and therefore absorbs X-rays effectively.   

Pharmacokinetics: 

Absorption 

drug is administered intravenously, typically as an injection, which ensures rapid and complete systemic absorption. Due to its water-soluble nature, iopamidol is quickly distributed throughout the body following injection. 

Distribution 

drug has a relatively large volume of distribution, which indicates extensive distribution into the extracellular space. It does not bind significantly to plasma proteins, so it remains mostly in the vascular compartment and is readily distributed to various tissues. 

Metabolism:  

drug is minimally metabolized in the body. It undergoes only limited biotransformation, primarily through enzymatic deiodination and glucuronidation processes. The main metabolic pathway involves the removal of iodine atoms from the iopamidol molecule, resulting in the formation of less iodinated derivatives. These metabolites are relatively inactive and are eliminated from the body. 

Excretion and Elimination 

drug is predominantly eliminated unchanged from the body through renal excretion. It is rapidly cleared from the bloodstream by glomerular filtration, and the majority of the administered dose is excreted in the urine within 24 hours. A small fraction of the dose may undergo biliary excretion, but this route is of minor significance. 

Adminstartion

Administration:  

Intravenous Injection: drug is typically administered via a peripheral vein, usually in the arm. The healthcare provider will insert a cannula or needle into the vein and carefully inject the contrast agent at the appropriate rate. The injection may cause a warm sensation or a metallic taste in the mouth, which is normal. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: iopamidol 

Why do we use iopamidol?  

Angiography: Drug is frequently used in angiography procedures, which involve imaging blood vessels. It helps visualize the blood vessels and detect abnormalities such as blockages, narrowing, or malformations. 

Computed Tomography (CT) Scans: Drug is often employed as a contrast agent in CT scans. It enhances the visibility of blood vessels, organs, and other structures, allowing for a more detailed and accurate diagnosis. 

Intravenous Urography: Drug can be used in intravenous urography (IVU) or excretory urography, which is an imaging technique used to evaluate the kidneys, ureters, and bladder. It helps outline the urinary tract and detect any abnormalities or obstructions. 

Arthrography: Drug can be used in arthrography procedures to examine joints such as the knee, shoulder, or hip. It is injected into the joint space to provide better visualization of the joint structures during X-ray or MRI scans. 

Myelography: Myelography is a diagnostic procedure used to evaluate the spinal cord and surrounding structures. Drug can be injected into the spinal canal to enhance the visibility of the spinal cord and nerve roots during X-ray or CT scans.